Why the clinical utility of diagnostic categories in psychiatry is intrinsically limited and how we can use new approaches to complement them
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Why the clinical utility of diagnostic categories in psychiatry is intrinsically limited and how we can use new approaches to complement them
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The DSM and ICD systems assume that diagnoses reflect underlying disease processes, but there is growing agreement that the current diagnostic categories for mental disorders lack clinical utility.
“The DSM and ICD systems assume that diagnoses reflect underlying disease processes, but there is growing agreement that the current diagnostic categories for mental disorders lack clinical utility [116].”
From Psychological Treatment of Exhaustion Due to Persistent Non-Traumatic Stress: A Scoping Review. (2024) · cites this paper as [116]
The Abstract says there is “no assumption” that diagnostic patterns are all discrete disease entities, contrary to the claim about underlying disease processes. It also says current diagnoses have clear implications for treatment and prognosis, though their usefulness has been overestimated and is intrinsically limited—not that they lack clinical utility. (LLM, conf=0.88)
Checked by a reasoning model — may be wrong.
Experimental — accuracy not yet measuredTransdiagnostic approaches have been suggested to complement current psychiatric nosography, which is intrinsically limited, in particular in young people, by integrating clinical staging models and optimizing preventive efforts.
“Transdiagnostic approaches have been suggested to complement current psychiatric nosography 208 , which is intrinsically limited, in particular in young people 209,210 , by integrating clinical staging models and optimizing preventive efforts.”
From Preventive psychiatry: a blueprint for improving the mental health of young people (2021) · cites this paper as [208]
There is broad agreement that DSM-5 categories have extremely limited clinical utility.
“There is now broad agreement that the clinical utility of DSM-5 categories is extremely limited (Maj, 2018)”
From A process-based approach to psychological diagnosis and treatment:The conceptual and treatment utility of an extended evolutionary meta model (2020) · cites this paper as Maj, 2018
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“In this line, Maj [10] argues that we do need current diagnostic categories, but the act of diagnosis is only one step in the process leading to the key aims of the optimal formulation of the management plan and the prediction of outcomes.”
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“In addition, they have made communication among clinicians, users and families less ambiguous; and they are useful for education and training as well as for reimbursement and insurance purposes (Galderisi, 2018; Jablensky, 2016; Maj, 2018).”
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“…. .] up to now, the first step (diagnosis) has received a lot of attention, with the production of several generations of tools providing systematic guidance to the clinician, whereas the second step (further characterization of the individual case) has been largely ignored [. . .]” (Maj, 2018).”
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“Currently available diagnostic systems have been criticised for having a limited clinical utility [1, 5, 17, 27].”
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“17 Research has shown that many of the DSM’s categories are, in fact, dimensional, and the thresholds (i.e. symptom is not pre-sent/symptom is present) are arbitrary ones (Maj 2018; Hen-gartner and Lehmann 2017).”
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“latest edition (May 2018) of the worldwide leading psychiatric journal World Psychiatry of the World Psychiatric Association, entitled “Why the clinical utility of diagnostic categories in psychiatry is intrinsically limited and how we can use new approaches to complement them”.(13) Alexandra Pârvan is right when she…”
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“Despite theseefforts,medicalontologiesoftenlackspeci fi cityforaparticulardisease and are in fl uenced by administrative processes 2,3 .”
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“…in child and adolescent diagnoses, and despite the continuing evolution of diagnostic criteria, some scholars argue that this approach has reached the limits of its clinical utility 35 , and this may particularly be the case in child and adolescent mental health 36 , due to several reasons.”
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“Moreover, when instituting a therapy or assessing a prognosis, it is important to focus on not only diagnosis but also other variables, such as personality traits, environmental exposures, and social functioning (Maj, 2018).”
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Development of the Dimensional Clinical Personality Inventory – Avoidant version based on the HiTOP
Carvalho, L. D. F., Ferraz, A. S., & Otoni, F. (2020) · Revista Avaliação Psicológica · doi:10.15689/ap.2020.1901.17046.04 · Cited by 3 · see citing works
“This taxonomic proposal intends to overcome some inconsistencies identified in the traditional classifications of mental disorders and, specifically PDs, although empirical evidence is just initial (see Maj, 2018).”
BackgroundBarone, E., Cassioli, E., Carfagno, M., Rossi, E., Marone, L., Tarchi, L., Raffone, F., Ricca, V., Castellini, G., & Monteleone, A. M. (2025) · Journal of Eating Disorders · doi:10.1186/s40337-025-01507-4 · Cited by 2 · see citing works
“Overall, the present findings support the need for clinicians and researchers to identify clinical and psychological phenotypes and to integrate them with the information derived from the diagnosis to personalize treatment approaches [59].”
Transdiagnostic stage-based monitoring of public mental health
Buchweitz, C., Viduani, A. C., Herrman, H., Kohrt, B. A., McGorry, P. D., Salum, G. A., Sartor, C., Saxena, S., & Kieling, C. (2026) · Nature Reviews Psychology · doi:10.1038/s44159-025-00527-w · Cited by 2 · see citing works
“Following previous literature 21,30,35 , we suggest that this goal could be achieved by integrating the clinical staging model into public mental health monitoring 34,36–39 .”
From symptoms to signatures: a transdiagnostic predictive coding framework for precision psychiatry
Lyndon, S. (2026) · Nature Mental Health · doi:10.1038/s44220-026-00607-7 · Cited by 2 · see citing works
Topography of depressive experiences. A dialectic approach
Messas, G. P., & Brencio, F. (2024) · Journal of Affective Disorders · doi:10.1016/j.jad.2024.10.064 · Cited by 2 · see citing works
MentalAId: an improved DenseNet model to assist scalable psychosis assessment
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“While these diagnostic criteria demonstrate moderate to high reliability, they require considerable expertise from experienced psychiatric specialists and remains controversial in describing the pathology of psychiatric disorders [4].”
Dondé, C., Dubertret, C., Fond, G. B., André, M., Berna, F. S., Boyer, L., Capdevielle, D., Chéreau, I., Coulon, N., Dorey, J., et al. (2022) · European Archives of Psychiatry and Clinical Neuroscience · doi:10.1007/s00406-022-01544-z · Cited by 2 · see citing works
“To help address this gap, further characterizations of discrete subgroups are warranted for a more personalized approach to healthcare [23, 41, 52].”
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“These models integrate neurobiological, cognitive, and behavioral dimensions; however, they have not produced a significant advance for clinicians given they were not able to date to provide useful prognostic and therapeutic indications [10].”
Changing The Definition of The Kilogram: Insights For Psychiatric Disease Classification
van Loo, H. M., Romeijn, J., & Kendler, K. S. (2019) · Philosophy, psychiatry & psychology · doi:10.1353/ppp.2019.0046 · Cited by 1 · see citing works
“For an example of an empirical validation of new data-driven subtypes of depression with respect to the specificity of course of illness, we refer to (van Loo et al., 2014; Wardenaar et al., 2014; Kessler et al., 2016) 5.”
Widnall, L.-A. (2020) · Dramatherapy · doi:10.1177/02630672211068261 · Cited by 1 · see citing works
“However, there is perhaps an opportunity for us to enter the reconceptualisation of mental health that the psychiatric community itself is being driven to do by advances in neuroscience and genetics as well as the now universal understanding of the impact of Adverse Child Experiences (Felitti et al., 1998; for a discu…”
BackgroundAn Updated Review of Werner Janzarik’s Psychopathological Model of Endogenous (Idiopathic) Psychoses
Luche, R. D., Giovannini, S., & Maggini, C. (2023) · American Journal of Psychiatry and Neuroscience · doi:10.11648/j.ajpn.20231103.11 · Cited by 1 · see citing works
Conceptualizing a less paranoid schizophrenia
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Course in Diagnosis of Psychotic Disorders: Research Agenda
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Does psychometry increase the quality of psychiatric diagnosis?
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Neuropsychiatric Manifestations Across Neurological Conditions
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Clinical Staging of Psychiatric Disorders: Its Utility in Mental Health Prevention
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New Perspectives in Eating Disorders
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The dimensionalization of schizophrenia(overview)
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Affective Temperaments and Seasonality in Patients with Mood Disorders
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“23,25,39 Melancholy and mania were described since ancient times, in typical association with autumn and summer, respectively, showing the relationship between seasonality and mood swings.”
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- Authors
- Maj, M.
- Affiliations
- University of Campania "Luigi Vanvitelli" (IT)
- Corresponding author
- Maj, Mario
- ORCID
- Maj, Mario
- Venue
- World Psychiatry
- Publisher
- Wiley
- Published
- 2018-05-24
- Volume
- 17
- Issue
- 2
- Pages
- 121-122
- ISSN
- 1723-8617 (ISSN-L)
- 2051-5545
- PMC
- PMC5980436
- OpenAlex
- W2806267370
- Cited by
- 109
- References
- 10
- Citations by year
- 2026: 12 · 2025: 7 · 2024: 16 · 2023: 7 · 2022: 14 · 2021: 14 · 2020: 17 · 2019: 16 · 2018: 6
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- World Psychiatry (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Archivio Istituzionale della Ricerca - Università degli Studi della Campania "Luigi Vanvitelli" (submittedVersion)
- Topics
- Social Sciences › Arts and Humanities › Philosophy › Mental Health and Psychiatry
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Mental Health Research Topics
- Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
- Keywords
- psychiatric diagnosis
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